ECZEMA: CAUSES AND TREATMENTS
Eczema, also known as dermatitis, is a condition that typically results in patches of dry, itchy skin. It’s not contagious and often varies from person to person, affecting around one in five children and one in 10 adults in the UK. People of all ages can develop eczema and it is typically considered a long-term condition, but there are ways you can manage its symptoms.
Here, we’ll explain the different symptoms often associated with eczema, its causes, and how you can care for your skin to help minimise your symptoms.
What is eczema?
Eczema is a topical skin condition often resulting in dry, red, and itchy skin. There are multiple types of eczema, and each one can affect different people at different times, with varying levels of severity.
Some of the different types of eczema
Atopic eczema (atopic dermatitis) – the most common form of eczema. It occurs mostly in children and typically develops before their first birthday. It can also affect adults and is considered a long-term condition, which can flare up later in life. Atopic eczema tends to run in families, so if your parents suffer from flare-ups, the chances are you will too.
Discoid eczema – a chronic skin condition that causes itchiness, redness, swelling, and cracking in circular or oval patches. It’s most common in older men (aged between 50 and 70) and younger women (in their teens to 20s). People who have discoid eczema often also suffer from atopic eczema.
Varicose eczema – a long-term condition also known by other names, including venous, gravitational, or stasis eczema. It shares its name with the condition varicose veins, which it commonly develops alongside, particularly in older women. In fact, this type of eczema affects as many as 70% of people over 70. People with a history of obesity or deep vein thrombosis are also more likely to develop varicose eczema.
Dyshidrotic eczema – also known as pompholyx, dyshidrotic eczema is usually a long-term condition that appears as small itchy blisters on the palms of the hands or soles of the feet. The symptoms typically come and go over a two-to-three-week period.
The causes and symptoms of eczema
There’s no single cause of eczema. Instead, most people find there are multiple causes of eczema that lead to flare-ups. However, there are certain things that are more likely to trigger specific types of eczema.
Atopic eczema (atopic dermatitis)
People with atopic eczema often have very dry skin that is unable to retain much moisture. When it dries out, skin is typically more sensitive to triggers such as certain materials, hormonal changes, allergens, and irritants like soaps or detergents. This can then make your skin itchy or sore.
Other common triggers include:
Food allergies
Dry or dusty air
Stress
Extremely hot or cold weather
Sweat.
It’s thought that genetics may play a part in causing atopic eczema, as it tends to run in families. Children who have one or more parents with atopic eczema, or have siblings with the condition, are more likely to develop it themselves. It isn’t infectious, so you won’t develop the condition simply from being in close contact with someone who has it.
People with active atopic eczema develop patches of itchy, dry, cracked, and sore skin, which are typically on the hands, insides of the elbows, and back of the knees. These patches may look bright red on lighter skin or dark brown or purple on darker skin shades. While these may be more severe during flare-ups, those with atopic eczema will usually have times when their symptoms are less noticeable.
Discoid eczema
Like atopic eczema, discoid eczema is caused by extremely dry skin that is prone to react to irritants, such as soaps. However, unlike atopic eczema, it isn’t known to run in families.
Discoid eczema flare-ups have also been linked to some medicines, including:
Interferon and ribavirin – when used in combination to treat hepatitis C.
Tumour necrosis factor-alpha (TNF-alpha) blockers – common arthritis treatments.
Statins (cholesterol-lowering medicine) – known to cause dry skin and rashes.
Other triggers for discoid eczema include:
Dry, cold environments.
Minor skin injuries, such as insect stings or bites or burns.
When it first develops, discoid eczema often appears as a group of small spots or bumps on the skin. Over time, these join to form larger patches of pink or red swollen and itchy skin. On darker skin, these patches can look dark brown and typically appear paler than the surrounding skin.
Varicose eczema
This is usually caused by increased pressure in the leg veins, which can cause fluid to leak into the surrounding tissue. The dry and flaky skin that comes with all types of eczema may, in this case, be the result of an immune response to the fluid leaking into tissues in that area of the body.
Some people seem to develop varicose eczema with no apparent cause, but there are certain things that can increase your risk of developing the condition. These include:
Gender – women are more likely to develop the condition than men.
Obesity – being overweight can increase the pressure on your lower legs, which is a major cause of varicose veins and, subsequently, varicose eczema.
Pregnancy – the added weight of pregnancy can also increase the pressure on the veins in your lower legs.
Lack of movement – being stationary for long periods of time can reduce circulation in your legs.
History of deep vein thrombosis (DVT) – blood clots caused by DVT can damage the veins in your lower legs.
Age – older people may have more difficulty with mobility, which can impact their circulation.
Varicose eczema has the typical symptoms of atopic eczema, such as patches of dry, flaking, and itchy skin, but can also cause discoloration of the legs, tender and tight skin, and pain. Some people also experience swelling in their lower legs, especially after standing for long periods.
Dyshidrotic eczema
The exact cause of dyshidrotic eczema is unclear. However, it’s common in people who regularly have wet hands (such as hairdressers). It has also been linked to:
Heat
Sweat
Stress
Sensitivity to certain metals
Strong chemicals in detergents and soaps.
Dyshidrotic eczema is common in people who have atopic eczema, with around 50% of sufferers of dyshidrotic eczema experiencing both conditions simultaneously. The condition can also develop alongside fungal infections, so it’s a good idea to check for any signs of infection before beginning treatment.
The earliest sign of this type of eczema is a burning or prickly sensation, which is shortly followed by the appearance of itchy blisters on the hands or feet. Symptoms typically come and go over a two-to-three-week period.
How to treat eczema
While there’s no cure for eczema, there are ways you can manage and reduce your symptoms to make it easier to continue with your everyday tasks.
Avoiding triggers
If your eczema is caused by an irritant, such as the chemicals in soaps, detergents, bubble baths, and shower gels, avoiding those triggers can help reduce the risk of flare ups. Even if your current soaps or toiletries aren’t obviously the cause of your eczema, you might benefit from switching to a fragrance-free, and more moisturising emollient-based soap.
Don’t scratch
The itching sensation caused by eczema can be hard to resist, but you should try to avoid scratching as much as possible. This could end up damaging the skin further, making the condition worse and increasing your risk of infection and scarring.
If you need to soothe the itching, try gently rubbing the patch of skin instead of scratching. Keeping your nails short and your skin covered as much as possible can also help to limit any damage caused by accidental scratching.
Emollients or topical corticosteroids
The main treatment for eczema is regular use of emollients (moisturisers) to help prevent or alleviate skin dryness. During a flare-up, topical corticosteroids can also be applied directly to the affected skin to reduce swelling and redness.
When using topical corticosteroids for your eczema, you should:
Apply your chosen emollient to the affected patch of skin. Don’t rub it too roughly as this could cause further irritation.
Allow 30 minutes for the emollient to soak into your skin.
Apply corticosteroid cream to the same patch of skin as recommended by the packaging or by your doctor.
Continue this process until 48 hours after your eczema flare up has calmed down.
Antihistamines
If you’re experiencing severe itching as a result of eczema on your hands, face, or other areas of your body, you may benefit from using antihistamines. If the itching is affecting your sleep, a sedating antihistamine that causes drowsiness may be useful.
Medicated bandages
Your GP may recommend using medicated bandages, clothing, or wet wraps to wear over the patches of skin affected by eczema. These are usually used alongside some form of topical cream, like emollients or corticosteroids, to help soothe the itching and inflammation. By covering the skin, the bandages help to prevent scratching, giving your skin time to heal. They also prevent the skin from drying out by keeping it moisturised.
Corticosteroid tablets
If your symptoms are severe, your GP may prescribe corticosteroid tablets. However, these are generally avoided as a form of chronic eczema treatment, as they carry potentially harmful side effects.
Eczema skin care tips
Caring for your skin is a great way to soothe and manage your eczema symptoms. The key is often to keep the skin’s moisture intact with emollients. This helps to protect the outermost layer of skin (called the stratum corneum), or skin barrier.
Eczema can damage this barrier, making the skin unable to retain water, which makes it dry and sensitive. This contributes to chronic dry, itchy skin, which can cause eczema to flare-up or get worse.
Here are some of our top tips for how to stop itching and improve your skin care for eczema:
Get the right moisturiser – choose an emollient or moisturiser that’s perfume- and additive-free as they’re typically gentler on your dry and sensitive skin.
Lock in moisture – to retain moisture, and ease symptoms of dryness and itching, try to apply an emollient every day, even when symptoms aren’t presenting.
Use plenty – the current recommendation is that an adult should use at least 500g of emollient every week, while children should use 250g. Don’t worry, as you cannot use too much.
Smooth, don’t rub – do not rub products in. Instead, gently smooth them onto your skin in the same direction your hair grows.
Be gentle – gently pat your skin dry after washing and apply the emollient while the skin is still damp. This helps retain moisture.
Use the correct utensils – avoid putting your hands into pots of emollient cream. Instead, use a utensil to take out the right amount and replace the lid of the tub after use. Alternatively, use a pump dispenser.
Care for your skin every day – you should care for your skin even if you don’t have an active flare-up. Products like AVEENO® Dermexa Daily Emollient Cream can help care for your skin on a daily basis, without the need for a complicated skin care routine.